Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy
Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy
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DOI：
10.1097/qad.0b013e32834e8805
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发表时间：
2012-01-28
期刊：
影响因子：
3.8
通讯作者：
Kirk, Ole
中科院分区：
文献类型：
--
作者：
Kowalska, Justyna D.;Reekie, Joanne;Kirk, Ole
背景资料：尽管已知联合抗逆转录病毒治疗（cART）的实质性益处，但累积的不良反应仍可能限制总体长期治疗益处。因此，我们调查了死亡率的变化，增加暴露于cART.Methods：共12 069例患者进行了随访，从基线，这是定义为开始cART或入组EuroSIDA的时间，以较晚者为准，直到死亡或6个月后，最后一次随访访视。计算每1000人-年随访（PYFU）的死亡发生率，并按暴露于cART（>= 3种抗逆转录病毒药物）的时间分层：小于2年、2 - 3.99年、4 - 5.99年、6 - 7.99年和8年以上。cART暴露持续时间是实际接受cART的累积时间。对每种死因分别拟合Poisson回归模型。在70 613 PYFU期间，共有1297例患者死亡[发生率为18.3/1000 PYFU，95%置信区间（CI）为17.4 - 19.4]，413例死于艾滋病（5.85，95% CI 5.28 - 6.41）和884例非AIDS相关原因（12.5，95% CI 11.7 - 13.3）。在调整了包括基线CD4细胞计数和HIV RNA在内的混杂变量后，在2至3.99年和更长的暴露时间之间，全因和艾滋病相关死亡率显著下降。在第一个2年的cART的非艾滋病死亡的风险显着降低，但没有显着差异的非艾滋病相关的死亡率之间的2和3.99年和更长的暴露cART observed.Conclusion：总之，我们没有发现任何证据的风险增加的全因和非艾滋病相关的死亡与长期累积的cART暴露。(C)2012年威科健康|利平科特威廉姆斯&威尔金斯
Background: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART.Methods: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (>= 3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately.Results: A total of 1297 patients died during 70 613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed.Conclusion: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure. (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins